Rabies treatment that saved a life to be tried again

Treatment that saved a life to be tried again

Published 5:30 am, Thursday, May 11, 2006

An experimental treatment doctors hope will save the life of an Humble teen infected with rabies could become the standard of care — whether or not it works this time.

Such is the desperation of physicians in the face of a truly horrifying disease. Rabies paralyzes its victims, robs them of speech and causes convulsions and coma before certain death.

With one exception.

A Milwaukee teen, Jeanna Giese, became the world's first known unvaccinated rabies survivor in 2004, after being treated with a unique combination of existing drugs described last year in the New England Journal of Medicine.

Since that 2004 success, the CDC has paired Willoughby with doctors treating other patients diagnosed with rabies on four occasions, including the critically ill Humble student at Texas Children's Hospital.

"If it can be done again, if you have a 100 percent fatal disease and you do something not once, but twice ... suddenly you've got yourself a cure," Willoughby said Wednesday. "If we can get one more, or two more (survivors), then scientifically it's a slam-dunk and we can start figuring out which piece is important."

In the New England Journal of Medicine, Willoughby and his colleagues described how they treated Giese with sedating and antiviral drugs, such as ribavirin and amantadine, after cautioning her parents "about the probable failure of antiviral therapy and the unknown effect of the proposed therapy, as well as the possibility of severe disability if the patient were to survive."

The Milwaukee doctors improvised the treatment approach after combing through reports of other human rabies cases. One hypothesis was that death resulted from a "neurotransmitter imbalance" in the brain. A search of neurotransmitters involved in rabies identified a drug called ketamine with specific activity against rabies in lab animals, so that drug was added to the mix.

Ribavirin, which Willoughby didn't consider useful for rabies, was recommended by the CDC. Since ribavirin protects the heart — and some patients with rabies die from cardiac arrest — he agreed to give it a try.

Giese was put into a medically induced coma to give the drugs and her immune system a chance to fight the disease. On the eighth day of her hospitalization, the teen's salivation — a hallmark of rabies — decreased. On the 10th day, she developed a high fever. But by the 19th day, she was able to wiggle her toes, gaze at her mother, and squeeze hands in response to commands.

Scientists still don't know precisely why Giese lived.

Willoughby said the protocol has not rescued other patients since then, but "none of those attempts have been even close to ideal." In one case, a transplant patient who developed rabies from infected tissue lived for 56 days. In another, a boy from India developed rabies despite being vaccinated.

Last month, Willoughby tried to help physicians treating a patient in Bangkok, but doctors could not obtain the necessary medications. The patient died.

Of the world's 55,000 human rabies infections each year, most occur in remote, poor settings where medical care is out of reach.

Willoughby said Giese's parents, who could not be reached for comment Wednesday, usually welcome the chance to talk about their daughter.

"But I wish they'd stop it," Willoughby said, "because she's got to go back to being a regular teenager."